This case report describes the successful treatment of a 59-year-old edentulous female patient with a two-implant overdenture. Two implants were placed in the mandible using a surgical guide. After osseointegration was confirmed, ball abutments were attached to the implants and connected to an overdenture with O-rings. The patient was able to eat with the new prosthesis. Follow-ups showed good outcomes with minor gingivitis resolved with education. The report concludes two-implant overdentures provide an affordable option for edentulous patients.
2. Minocha, et al.: Implant supported overdenture
Journal of Clinical Research in Dentistry • Vol 3 • Issue 1 • 2020
maxillary and mandibular fully bony anchored prosthesis as the
first choice or a removable prosthetic option for both maxillary
and mandibular residual alveolar ridges with a minimum
of two implants. The patient did not consent, for maxillary
implant-supported prosthesis, but consented for mandibular
two implant-supported overdentures. A complete denture with
bilateral balanced occlusion was fabricated for the patient
using routine clinical and laboratory procedures. The denture
was duplicated into a clear acrylic surgical guide which was
used to place two fixtures (Nobel Bio care, Goteborg, Sweden)
during a stage one surgery [Figure 1b]. After placing the
implant fixture [Figure 1c], the alignment between the two
implant bodies was verified with guide pins [Figure 1d],
following which the area was approximated with nylon sutures
[Figure 1e]. The patient was put on a course of antibiotics
and anti-inflammatory analgesics for a 2 week period. These
included a broad spectrum of amoxicillin (500 mg) and
diclofenac sodium (50 mg). The sutures were removed after
a week following which the patient was instructed to wear the
complete denture that was relieved in the surgical area. After a
period of 4 months, the osseointegration was radiographically
verified [Figure 1f]. In the second stage, the implant area was
exposed locally [Figure 2a] and a healing cover was placed
over the implant fixture after using the locator bar (#8589-2)
attachment [Figure 2b].
The patient was asked to continue wearing complete dentures
with additional relief provided in the implant area. Once the
gingival healing was completed, the healing caps were removed
and the abutment was selected after measuring the tissue
thickness from the apical rim of the implant body to gingival
crest. Two ball abutments were placed over the implant fixture
[Figure 2c] and their respective O rings [Figure 2d] were placed
over the ball head. The denture was relieved in the area and
the two rings were attached to the denture using self-cure fast
setting pink acrylic resin [Figures 1 and 2e]. Excess acrylic
was allowed to flow through the lingual surface of the denture
[Figure 2f]. The patient continued to wear the modified denture
using implant retained attachments. The patient was put on a
follow-up for a period of 1 year where the patient was evaluated
by a team of a periodontist and a prosthodontist. At the first
follow-up visit, there was mild gingivitis around the right
abutment due to the settling of the denture on one side. The
patient was eating only on one side and therefore was educated
about a new masticatory pattern that she has to follow. The
condition was resolved and verified at the next follow-up visit.
DISCUSSION
The use of two implants to support an overdenture is the
minimum requirement for implant prosthetic option, although
more than two can be placed and are desirable. Using a four
implant overdenture since not being always ideal, therefore, is
an additional financial burden to the patient.[6]
The treatment
modality of implant overdenture has evolved from the fixed
tissue-integrated prosthesis in which the alignment of various
implants determines the successful placement of the fixed
restoration.[7]
The abutment alignment is therefore critical and
the criticality increases as the number of implants increases.
The two implants can either be splinted together with a bar or
they can be given individually as in this case. The advantage of
keeping the two implant abutments separated is that only one
side needs to be corrected in case there is any error in alignment
with the denture.[8]
In the case of bar supported overdenture, if
there is any change of alignment on one side, the entire bar is
affected. The individual implant also provides better hygiene
maintenance around the implant, especially on mesial surfaces.
Oral hygiene maintenance does not require special aids like
Figure 2: (a) Exposing implant area (b) healing screw
(c) abutments placed on the fixture (d) O-rings placed on
the abutment (e) finished complete denture tissue surface
(f) finished lingual surface
Figure 1: (a) Pre-operative radiograph (b) surgical guide
(c) implant placement (d) guide pin verification (e) suture
placement (f) post-operative radiograph
a
b
c
d
e
f
a
b
c
d
e
f
3. Minocha, et al.: Implant supported overdenture
Journal of Clinical Research in Dentistry • Vol 3 • Issue 1 • 2020 5
interdental brushes. Technically, the two implants using a ball
and o ring attachment are less technique sensitive in terms
of material errors that are incorporated within a prosthesis.
Most of the material induced errors are not under the control
of the operator and hence are incorporated irrespectively.
The efficiency of complete denture prosthesis is enhanced
since the prosthesis is stable over the abutments. Shifting of
occlusal surfaces during mastication increases chewing time
by decreasing the cuspal efficiency of food penetration.
CONCLUSION
Economic viability in the middle- and low-income country
makes 2/2 implant overdenture prosthetic options more
attractive for both dentist and patient. Since there is no
added procedure of casting alloys like that of a bar supported
overdenture, the individual attachment supported overdenture
becomes even cheaper than its counterpart.
ACKNOWLEDGMENTS
The authors would like to acknowledge the efforts of the
laboratory technician Mr Shuja for his meticulous laboratory
work.
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Howtocitethisarticle:MinochaT,MattooK,RathiN.An
2/2 Implant Overdenture. J Clin Res Dent 2020;3(1):3-5.